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Permit No. 1059000672 � . . ' 4111 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 00672 205A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 03/29/90 I ISSUE DATE 03/29/90 I PG 1 OF 1 PARCEL NUMBER 1023-371-21-0000 PROPOSED USE: STORAGE BUILDING CURRENT USE: RESIDENCE 12581TRAC7 1000 10LOT 57 I SSEC W08 170WNS 08WW PRCL MAP I PRCL ACTIVITY : L823 0COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT 1 GROUP R3 SHORT, RICHARD A. 13426 PARKVIEW TERRACE . *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 31-134 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 868 - 4468 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER SHORT, RICHARD A. 4 64 .50 32.00 13426 PARKVIEW TERRACE . CHINO HILLS CA 91709-0000 CALC. VALU 1,440.00 I ADJUSTED AREA 32 (714) 868 - 4468 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS, RESIDENTIAL CONSTRU 35.45 x"` 13426 PARKVIEW TERRACE . ISSUANCE FEE 16.96 CHINO HILLS CA 91709-0000 TOTAL AMOUNT 52.41 CROSS STREET MITCHELL DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE HOWENCY CRESCENT R/W 50 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO.UNITDWELLING I NO. BEDROOMS I CONCRETELO EXT. WALLS INT. WALLS I CEILING ROOFHEATING FIREPLACES WOOD I METAL IMASRY PWATIR WATER-1 SEWER I MIN NODEPTHI S.F./100IOOOOII EI NEW/REPAIR 000 COMMENTS OrO f' ND' TED LAY ra i r:. . 17-fa Pria .0.0( AMT WAIVED .00 AMT PAID 52.41 PAYOR NAME: RICHARD SHORT PAID 03/29/90 RECEIPT 1171 EMPL: ADAMS, C PAID BY : CHECK NBR : 2090 # LICENSED CONTRACTORS DECLARATION (III I ?\ ..":--.5.7-::::,,,...7E7,-,::,, _` 51✓'`C 9 " _'ON _3: CF \' . . _ =, ,J' z. 1 LICENSE CL-SE JC_NSE NUMEEP CDN _ - OWNER-BUILDER DECLARATION 1 I HEREBY AFIRM THAT'AM E)EMP'=RDt.M THE CONTRACTORS LICENSE LAW FOR THE FOLLOV,I'\C REASON(SECTION 7051 5 BUSINESS AND PRORESSIDNS CODE ( ANY CITY OR COUNTY V.nIC- REQUIRES A PERM,T TO CONSTRUCT ALTER IMPROVE DEMOL'SH OR REPAIR ANY STRUCTURE PRIOR TO ITS ISS.:ANCE ALSO 1 REQUIRES THE APPLICANT FOP SUCH ERM,T TO PILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PUPSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW(CHAPTER 9(COMMENCING W ITn SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM i AND THE BASIS FOR THE ALLEGED EXEMPTION ANY VIOLATION OF SECTION 7031 5 EY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL 1 PENALTY- OF NOT MORE THAN FIVE HUNDRED DOLLARS 15500) I L1� I,AS OWNER OF THE PRORERTY,OR MY EMPL OT EEES WITH WAGES AS THEIR SOLE COMPENSATION WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED / OR OFFERED FOR SALE(SECTION 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE, IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) ❑ I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO .\ CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC /��/�N /1 n �Q /�,) B AND P C FO T IS REASON 1 OWNER R IC�- 191 V 5 Y7"" ' \ r g._, /Q DATE 971-c/ / / 6 WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM THAT I HAVE A CERTIFICATE OF CONSENT TO SELF-INSURE OR A CERTIFICATE OF WORKERS'COMPENSATION INSURANCE OR A CERTIFIED COPY THEREOF(SEC. 3800, LAB C) • - - POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED 0 CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT - APPLICANT DATE CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 151001 OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA APPLICANT DATE .1 NOTICE TO APPLICANT IF,AFTER MAKING THIS CERTIFICATE OF EXEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS 1 OF THE LABOR CODE, YOU MUST FORTHWITH COMPLY WITH SUCH PROVISIONS OR THIS PERMIT SHALL BE DEEMED REVOKED 4 I CONSTRUCTION LENDING AGENCY I I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS ! DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW i ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL i BE MORE THAN 36 FEET HIGH ❑ AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION 1 DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER i I I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY VLORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY::: 1N SPECIOPUS � SIGNATURE OF APPLICANT OR /�4 DATF /z--7 "/ a V EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUANCE OF SUCH PERMIT OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS FEES PAID ARE NOT ' RERJNDABLE AFTER 180 DAYS FROM DATE OF PAYMENT, EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT AU.FEES PAID MAY NOT BE REFUNDABLE. Owner•Name 5/:ZOZ/ Permit Num 70Z7/16r/ /, INSPECTION RECORD DATE INSPECTOR DATE I INSPECTOR Setback 46-g-,9® O, Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms L/-5 're) Insulation F H A Foundation Req Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A C Final Bond Beam Final Construction Q. 7,. Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation 6-fig. Final Dedication Roof Covering I4... .g Final Zoning Rough Heating Final Electrical Electrical Service and Ground I Final Gas Rough Electrical I Developer Fees Paid WC (Y/N) Ind Saf (Y/N) Certificate of Occupancy SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N V" Rit f.„4:, clam cTm� .b r ice [� n L.!izo r r m n i_ g A l:5 . dr S Inspector's Signature and Initials ✓ 401. 04.044,4.1 12-17589-489 Rev 3/88